Effective Strategies for Elderly, Hypertensive, and Diabetic Populations with TB

Prioritizing TB Control Among the Elderly:

• Critical Need: As countries near TB elimination, focusing on elderly TB control is crucial due to age-related disparities in TB burden.
• Immune Senescence: Older individuals with latent TB are at higher risk of developing active TB due to weakened immune systems, making immune senescence a significant factor in TB progression.
• Declining Transmission: Improved living conditions have reduced TB transmission, with older generations being more likely exposed in the past.
• Age-specific Interaction: Elders primarily interact within their age group, limiting TB spread to younger populations.
• Targeted Strategies: Control efforts should prioritize preventing disease progression in the elderly by addressing immune senescence and implementing age-specific interventions.

Hypertension, Diabetes, and TB Outcomes:

• Increased Mortality in Hypertensive Patients: Hypertensive TB patients show higher all-cause and infection-related mortality during the first 9 months of treatment, despite similar microbiological outcomes compared to normotensive patients.
• Impact of Non-DHP-CCBs: Non-dihydropyridine calcium channel blockers (non-DHP-CCBs) like verapamil enhance bedaquiline’s effectiveness, reducing bacillary load and improving 9-month all-cause mortality in hypertensive TB patients.
• Screening Importance: Hypertension screening in TB patients, especially the elderly, is essential to improve treatment outcomes.
• Diabetes Complications: Diabetic TB patients face higher risks of treatment failure, death, and recurrent TB compared to non-diabetic patients.
• Management Programs: Enhanced case management programs for diabetic patients reduce the likelihood of developing TB and improve outcomes for those who do.

TB Epidemiology and Global Public Health Challenges:

• Global Variation: TB presents varying challenges across countries, with high-incidence regions focusing on prompt diagnosis and treatment, while low-incidence regions focus on managing latent TB infections.
• Impact of Diabetes: Diabetes mellitus (DM) significantly increases the risk of active TB, poor treatment outcomes, and TB recurrence across both high and low/moderate TB incidence countries.
• Shifting Burden: In low/moderate TB incidence countries, the burden is shifting towards elderly populations, particularly among those with diabetes.
• Obesity and TB Risk: Obesity significantly reduces TB risk compared to normal weight individuals, even after adjusting for diabetes and other factors.

TB in the WHO Southeast Asia Region (WHO SEAR):

• High Burden: Despite declining incidence, TB remains a significant challenge in WHO SEAR, which accounts for nearly half of all new TB cases and over 50% of TB deaths globally (excluding TB-HIV coinfection).
• Funding Needs: Increased domestic and donor funding is crucial to prevent TB from remaining a serious threat by 2030, particularly in Bangladesh, India, and Indonesia, where public health spending is low.
• Capacity Building: Strengthening the capacity to absorb and efficiently spend funds is essential for expanding future TB funding.
• Private Sector Engagement: Leveraging Corporate Social Responsibility (CSR) mandates and engaging the private sector can raise additional resources and enhance TB program effectiveness.
• Results-based Financing: Implementing results-based financing can improve spending efficiency and reduce the need for additional resources in resource-constrained settings.

Read more: https://tbreadingnotes.blogspot.com/

References:

1.     Fu, H., Lin, HH., Hallett, T.B. et al. Explaining age disparities in tuberculosis burden in Taiwan: a modelling study. BMC Infect Dis 20, 191 (2020).

2.     Chidambaram, V., Gupte, A., Wang, J.Y., Golub, J.E. and Karakousis, P.C., 2021. The impact of hypertension and use of calcium channel blockers on tuberculosis treatment outcomes. Clinical Infectious Diseases, 73(9), pp.e3409-e3418.

3.     Lo, H.Y., Yang, S.L., Lin, H.H., Bai, K.J., Lee, J.J., Lee, T.I. and Chiang, C.Y., 2016. Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?. The International Journal of Tuberculosis and Lung Disease, 20(3), pp.376-382.

4.     Lee, P.H., Fu, H., Lee, M.R., Magee, M. and Lin, H.H., 2018. Tuberculosis and diabetes in low and moderate tuberculosis incidence countries. The International Journal of Tuberculosis and Lung Disease, 22(1), pp.7-16.

5.     Bhatia V, Srivastava R, Reddy KS, et al. Ending TB in Southeast Asia: current resources are not enough. BMJ Global Health 2020;5:e002073.

TBC 007